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PATIENT PRESENTATION

Chief Complaint

Nausea, constipation

History of Present Illness

R.M., a 43-year-old obese female, presented to the hospital emergency department with complaints of atypical chest pain, stomach discomfort/nausea, vomiting and constipation. The patient has a PHM of pulmonary embolism, hypertension, iron deficiency anemia, gastric by-pass surgery, polysubstance use disorder and fibromyalgia.

Student Work-Up

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Missing Information?

Evaluate:

Patient Database

Drug Therapy Problems

Care Plan (by Problem)

TARGETED QUESTIONS

  1. How should constipation be evaluated in R.M.? Is she constipated?

    Hint: See Constipation in PPP

  2. What is the clinical presentation of constipation?

    Hint: See Constipation in PPP

  3. What are R.M.’s contributing causes of constipation?

    Hint: See Table 22-1 in PPP

  4. Which of R.M.’s medications are commonly associated with causing constipation?

    Hint: See Table 22-1 in PPP

  5. Are R.M.’s laxatives being used appropriately?

    Hint: See Tables 22-2 in PPP

FOLLOW-UP

How should R.M. be educated about methods of avoiding constipation?

Hint: See Constipation in PPP

CASE SUMMARY

Global Perspective

According to the World Gastroenterology Organization, constipation is not a disease. It is a symptom. Different patients can have different perceptions of constipation. The clinical view of constipation may differ from the patients’ perception of constipation. (Worldgastroenterology.org) According to the American Gastroenterologists Association, constipation is a frequent diagnosis that is made in the ambulatory population and is a common cause of patient clinical referrals to gastroenterologists. There is a 15 % worldwide prevalence of chronic constipation. Symptoms can vary from person to person and can include incomplete evacuation, straining on defecation, a sense of anorectal blockage, or decreased stool frequency. Patient history analysis, physical examination, diagnostic testing, and individualized treatment are important factors in providing care for patients who are constipated.

Key References

1. +
Bharucha  AE, Lacy  BE. Mechanisms, Evaluation, and Management of Chronic Constipation. Gastroenterology 2020;158:1232–1249.) https://doi.org/10.1053/j.gastro.2019.12.034  [PubMed: 31945360]

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